Provider Demographics
NPI:1255669560
Name:HOGAN, JEANNETTE T (RPT)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:T
Last Name:HOGAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GONYEAU RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05667-9669
Mailing Address - Country:US
Mailing Address - Phone:802-479-2723
Mailing Address - Fax:802-479-2723
Practice Address - Street 1:324 GONYEAU RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:VT
Practice Address - Zip Code:05667-9669
Practice Address - Country:US
Practice Address - Phone:802-479-2723
Practice Address - Fax:802-479-2723
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-00007632251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics